Basic Information
| Provider Information | |||||||||
| NPI: | 1144560509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | IRENE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S.,LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 PENNSYLVANIA AVE SE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200034318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025445440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 650 PENNSYLVANIA AVE SE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200034318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025445440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2013 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PRC14229 | DC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.